Moreover, the researchers found that, in some cases, routine use of episiotomy causes more harm to mothers than avoiding its use. An episiotomy is an incision made at the vaginal opening during a birth. This study addressed routine use only, not emergencies.

In routine births, women without episiotomy were found to have less pain with faster resolution, and no greater or lesser risk of wound healing complications. In addition, the evidence showed that episiotomy did not protect women against urinary or faecal incontinence or pelvic organ prolapse in the first three months to five years following delivery.

"The literature we reviewed suggests that the outcomes with spontaneous tears, if they happen, are better than with episiotomy," said Dr. Katherine Hartmann, the lead author of the JAMA article and assistant professor of obstetrics and gynecology in the University of North Carolina at Chapel Hill's School of Medicine. She noted that women are more likely to suffer the most severe types of tears, from the vagina into the rectum, when they have an episiotomy.

A key message from such findings, she added, is that a mother-to-be should talk to her doctor about her wishes regarding episiotomy during her prenatal care because it will be too late to have an informed discussion in the delivery room.

"You're in charge of what happens to you in your care. Your best bet to reach a clear understanding with your doctor about what this aspect of your birth will be like is to talk about it in advance."